1. Field of the Invention
The invention relates to bariatric surgery. More particularly, the invention relates to a medical instrument and associated procedure for manipulation of the gastric cavity to enhance the treatment thereof.
2. Description of the Related Art
During advanced endoscopic procedures, such as, endoscopic gastric restriction for obesity it is oftentimes necessary to secure anterior and posterior stomach walls in an effort to reduce stomach volume. More particularly, endolumenal vertical gastric restriction requires fastening of the internal walls (mucosal surface) of the stomach. This is true for purely endoscopic or hybrid (that is, laparoscopic/endoscopic) features. For the purposes of the present disclosure, the term endoscopic is intended to refer to procedures where access to the body is achieved via a natural body orifice for example, transorally, while the term laparoscopic is intended to refer to procedures where access to the body is achieved via a surgically created incision, for example, through the use of a trocar. The key requirements of these procedures are entry to the site, visualization of the site, orientation of the medical instrument and verification of proper location for restriction.
In practice, one must repeatably acquire the correct zone of tissue on the anterior and posterior walls of the stomach. The gastric restriction procedure requires durability of the restricted gastric cavity, which may only be achieved if the mucosal surfaces to be joined are injured, preferably excised such that the body's healing mechanism steps in and heals opposed mucosal surfaces together. The gastric restriction procedure also requires the ability to extract injured tissue (through debridement or tissue removal) from the site as may or may not be mandatory and the ability to accurately join injured zones precisely such that they line up along the anterior and posterior aspect. The gastric restriction procedure also requires the ability to appose mucosa on both sides of the anterior and posterior junction line to seal off the injured area and enhance sealing, as well as the ability to fasten opposing walls together to form a restriction.
To accomplish these goals via natural orifice access only, all devices must flex appropriately and be sized for insertion down the esophagus, which imposes a roughly 16 mm diameter size limitation and a 40-50 mm rigid length segment limitation in order to pass the flexure of the pharynx. In addition, all mechanisms must be actuated through a flexible shaft. This is a difficult task. There is also a great deal of doubt as to whether surgeons will switch from laparoscopic procedures, which are already minimally invasive and which are already being used throughout the industry, to endoscopic procedures with their steep learning curve and high difficulty of use for the benefits of a few less scars. There is, therefore, a need for an approach of performing gastric restriction that allows greater flexibility of usability, design, and robustness that can be achieved via an endoscopic approach only.
As such, a need exists for endoscopic and/or laparoscopic medical instruments and procedures overcoming these shortcomings in the currently existing technology. The present invention provides such a medical instrument and procedure.